股骨粗隆间骨折患者PFNA术后骨折不愈合的影响因素分析

Influencing factors of fracture nonunion after PFNA in patients with intertrochanteric fracture

目的分析股骨粗隆间骨折PFNA术后骨折不愈合的影响因素。方法回顾性分析2018年3月至2019年1月于本院行PFNA术治疗的股骨粗隆间骨折患者126例临床完整资料,根据患者术后1个月X线检查骨折愈合情况将其分为骨折不愈合组(n=12)和骨折愈合组(n=114),对比两组基本资料,对可能诱发患者PFNA术后骨折不愈合相关影响因素进行分析。结果两组年龄、骨折稳定性、螺钉深度不够、螺钉位置不良比较,差异均有统计学意义(均P<0.05);经非条件Logistic回归分析结果显示,年龄、骨折稳定性、螺钉深度不够、螺钉位置不良是股骨粗隆间骨折PFNA术后骨折不愈合的危险因素(OR>1,P<0.05);骨折稳定性是股骨粗隆间骨折PFNA术后骨折愈合的保护因素(OR<1,P<0.05)。结论年龄、术中螺钉置入深度及螺钉位置是影响股骨粗隆间骨折PFNA术后骨折不愈合的独立危险因素,骨折稳定性是骨折愈合的保护因素,临床中应准确掌握相关危险因素,积极做好相关预防及处理工作。

Objective To analyze the influencing factors of fracture nonunion after PFNA in patients with intertrochanteric fractures.Methods 126 cases of femoral intertrochanteric fractures treated with PFNA in our hospital from March,2018 to January,2019 was performed.According to the patients’1 month postoperative X-ray examination of fracture healing,they were divided into a fracture nonunion group(n=12)and a fracture healed group(n=114).The basic data,such as gender,age,fracture cause,fracture classification,and comorbidity,were compared between the two groups.Unconditional logistic regression was used to analyze the multiple factors.The possible influencing factors were analyzed.Results There were statistical differences in age,fracture stability,insufficient screw depth,and poor screw position between the two groups(all P<0.05).Unconditional logistic regression analysis showed that age,fracture stability,insufficientscrew depth,poor screw position,and operation time were the risk factors for nonunion of after PFNA for femoral intertrochanteric fracture(all OR>1;all P<0.05);and fracture stability was a protective factor for fracture healing after PFNA for intertrochanteric fracture(OR<1;P<0.05).Conclusion Age,intraoperative screw placement depth,and screw position are independent risk factors for fracture nonunion after PFNA for intertrochanteric fracture.Fracture stability is a protective factor for fracture healing.Relevant risk factors should be clinically known well,and relevant prevention and treatment work should be done.